Preschooler remains hospitalized, conscious, but unable to talk, get up

﻿Craig Jacobs, Nevaeh Hall's mother Courissa and family members look on as attorney Jim Moriarty﻿ shows a ﻿graph depicting ﻿﻿ the EKG and oxygen levels during the 4-year-old's dental appointment.﻿

Photo: Craig Hartley Craig Hartley, Freelance

On Jan. 6, Nevaeh Hall was running, playing and laughing at a Chuck E. Cheese indoor playground and game room.

The next day, after a morning dental appointment, the 4 year old was in an ambulance en route to Texas Children's Hospital.

Tests showed severe brain damage that the child's mother and her lawyer blame on the girl's confinement in a restraining device known as a papoose. Some dentists use the apparatus to immobilize children for procedures.

Courissa Clark said her daughter had been restrained at Diamond Dental on a previous visit for tooth caps. She said she knew the apparatus would be used again on Jan. 7 when Dr. Bethaniel Jefferson saw the little girl to stabilize decayed teeth.

"They made it seem like it was for her safety so she wouldn't fall off the table or put her hands in her mouth," said Clark, 23.

Nevaeh has been diagnosed with dystonia, or involuntary muscle contractions, and remains in the hospital.

"She's constantly moving her arms and having muscle spasms," Clark said. "She's agitated a lot. She cries most days."

Her condition was reported in testimony and documents to the State Office of Administrative Hearings.

On Jan. 20, the executive committee of the Texas State Board of Dental Examiners temporarily suspended Jefferson's license based on Nevaeh's incident. The action was taken during an emergency meeting, called "when something is going to present a clear, eminent or continuing threat to a person's physical health or well-being," said Texas dental board spokeswoman Lara Anton.

Efforts to reach Jefferson via phone and email were unsuccessful, as were attempts to contact her attorney.

Nevaeh, a once-vibrant preschooler, is conscious. She opens her eyes. But she does not respond anymore when her name is called. She cannot talk. She cannot get up.

Clark, along with relatives and her lawyer, Jim Moriarty, convened reporters on Thursday to discuss Nevaeh's condition and to publicly warn parents about the use of immobilizers during pediatric dental procedures.

"We've got to get the American public to understand: You cannot allow your child to be held in a restraint device without you personally being present," Moriarty said. Clark said she was present when the child was sedated with gas, but not restrained, then complied when she was asked to leave.

Previous reprimand

Nevaeh's family hired Moriarty about a month ago. He said Texas law prevents him from filing a civil action until a medical expert reviews the records and provides a report on the extent of the alleged liability.

In February, an administrative law judge upheld Jefferson's dental license suspension. A revocation hearing is scheduled for later this month.

Jefferson, a general dentist and 2003 graduate of the University of Missouri-Kansas City dental school, was reprimanded in 2005 for not making notations of vital signs for a patient and again in 2012 for failing to properly sedate a child.

According to the Texas dental board's administrative code, only dentists with "advanced training" should use the restraint technique in urgent circumstances or for uncooperative patients and should consider having a parent or guardian present if the patient is a minor. The American Academy of Pediatric Dentistry has issued recommendations that mirror Texas guidelines and notes that the restraint may lead to serious "physical or psychological harm."

Moriarty alleges that the Medicaid system financially rewards dentists who perform multiple procedures. Strapping down children, he said, enables the dentists to work more quickly.

The high-profile case of Jahi McMath, a California 13-year-old declared brain dead after tonsil surgery in 2013, brought the potential dangers of pediatric oral procedures to the public's attention.

'Everything was OK'

In Nevaeh's case, Clark said she heard her daughter crying about two hours into the appointment. When she went into the procedure room, Nevaeh wasn't in a restraint, but Jefferson was holding the child's flailing arms, Clark said.

According to Clark, Jefferson asked if there was any family history of "shaking," but she doesn't recall the word "seizure" being used.

"When I went back there and saw her, my first question was: 'OK, do we need to call the ambulance or are you all going to call the ambulance? And they said: We're just going to try to get her to calm down. We're going to monitor her. We're going to watch her. You guys have nothing to worry about, but we do need you all to wait in the waiting room and let her rest so she can walk back out of here,' " Clark said.

"The whole time they just assured us that everything was OK. The next time we were allowed to come in is when the paramedics were actually coming back."

'Didn't have to happen'

According to Moriarty and State Office of Administrative Hearings documents, Nevaeh's vital signs worsened around noon. The records show the girl was given too many medications for her 30-pound body, Moriarty said.

"This child started suffering severe lack of oxygen. In essence what happened is this child was chemically and physically suffocated," the lawyer contends. "911 wasn't called until close to 4 o'clock. This child suffered massive brain damage during that time period and that didn't have to happen."

Moriarty has been suing pediatric dental clinics for the last six years and has reached a multimillion-dollar settlement with the Small Smiles dental chain. He was hired by the state of Texas to investigate a dramatic increase in Medicaid bills by Texas orthodontists.

Diamond Dental at 15531 Kuykendahl Road in north Harris County appears to be closed.